Progress towards malaria elimination in Sabang Municipality, Aceh, Indonesia
Progress towards malaria elimination in Sabang Municipality, Aceh, Indonesia
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DOI：
10.1186/1475-2875-12-42
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发表时间：
2013-01-30
期刊：
影响因子：
3
通讯作者：
Hawley, William A.
中科院分区：
文献类型：
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作者：
Herdiana, Herdiana;Fuad, Anis;Hawley, William A.
背景资料：印度尼西亚将2030年定为在群岛消除疟疾传播的最后期限，并根据目前疟疾流行程度和卫生基础设施的实力确定区域最后期限。方法：2008 - 2010年，在印尼亚齐省沙邦市开展疟疾干预基线调查、疟疾确诊病例摸底调查、疟疾传播残留疫源地分类调查和媒介调查。为了为今后的消灭工作提供信息，在重点地区进行了大规模筛查，用显微镜和聚合酶链反应测量疟疾流行率。G6 PD缺乏症患病率也measured.Result：尽管它的小尺寸，不同的混合物的潜在的疟疾媒介记录在沙邦，包括孙代按蚊，微小按蚊，按蚊aconitus和大劣按蚊。在两年的时间里，疟疾持续传播的村庄从61个减少到43个。疟疾诊断和治疗、室内滞留喷雾杀虫剂和长效驱虫蚊帐的覆盖率超过80%。对16,229名居民进行筛查，检出阳性者19人，点患病率为0.12%。在19例阳性病例中，3例有症状感染者和5例无症状感染者经显微镜检测，11例无症状感染者经PCR检测。在19例病例中，7例感染了恶性疟原虫，11例感染了间日疟原虫，1例受试者同时感染了两种疟原虫。对937份G6 PD缺乏症血液样本的分析显示，2名受试者（0.2%）患有G6 PD缺乏症。讨论：过去7年来，沙邦政府采取的干预措施大大减轻了疟疾的负担。第一阶段在2005年至2007年期间实施，包括改进疟疾诊断、采用青蒿素综合疗法治疗以及扩大室内滞留喷雾杀虫剂和长效驱虫蚊帐的覆盖面。第二阶段从2008年至2010年，旨在消除疟疾的持续残留传播，包括建立疟疾数据库以确保迅速报告和调查病例，对疟疾疫源地进行分层以指导干预措施，以及积极发现病例以寻找有症状和无症状的疟疾携带者。
Background: Indonesia has set 2030 as its deadline for elimination of malaria transmission in the archipelago, with regional deadlines established according to present levels of malaria endemicity and strength of health infrastructure. The Municipality of Sabang which historically had one of the highest levels of malaria in Aceh province aims to achieve elimination by the end of 2013.Method: From 2008 to 2010, baseline surveys of malaria interventions, mapping of all confirmed malaria cases, categorization of residual foci of malaria transmission and vector surveys were conducted in Sabang, Aceh, a pilot district for malaria elimination in Indonesia. To inform future elimination efforts, mass screening from the focal areas to measure prevalence of malaria with both microscopy and PCR was conducted. G6PD deficiency prevalence was also measured.Result: Despite its small size, a diverse mixture of potential malaria vectors were documented in Sabang, including Anopheles sundaicus, Anopheles minimus, Anopheles aconitus and Anopheles dirus. Over a two-year span, the number of sub-villages with ongoing malaria transmission reduced from 61 to 43. Coverage of malaria diagnosis and treatment, IRS, and LLINs was over 80%. Screening of 16,229 residents detected 19 positive people, for a point prevalence of 0.12%. Of the 19 positive cases, three symptomatic infections and five asymptomatic infections were detected with microscopy and 11 asymptomatic infections were detected with PCR. Of the 19 cases, seven were infected with Plasmodium falciparum, 11 were infected with Plasmodium vivax, and one subject was infected with both species. Analysis of the 937 blood samples for G6PD deficiency revealed two subjects (0.2%) with deficient G6PD.Discussion: The interventions carried out by the government of Sabang have dramatically reduced the burden of malaria over the past seven years. The first phase, carried out between 2005 and 2007, included improved malaria diagnosis, introduction of ACT for treatment, and scale-up of coverage of IRS and LLINs. The second phase, from 2008 to 2010, initiated to eliminate the persistent residual transmission of malaria, consisted of development of a malaria database to ensure rapid case reporting and investigation, stratification of malaria foci to guide interventions, and active case detection to hunt symptomatic and asymptomatic malaria carriers.